A new and promising treatment is giving victims of Crohn's disease hope for a possible remission of this incurable and devastating inflammatory bowel disease.

Though not life-threatening, Crohn's can imprison a person by making it virtually impossible to leave home, be away from a bathroom, be free of debilitating cramps, or in some cases even to sit down without pain.

“It's a disease that affects all capacities of life,” said physician's assistant Merriman Dowdle. Patients seeking relief from the ravages of Crohn's have been referred to MUSC's Digestive Disease Center from throughout the state, leading Dowdle and gastroenterologist Frederick Wilson, M.D., to consider establishing an inflammatory bowel disease (IBD) center here.

Encouraging them is a new weapon in the arsenal against Crohn's, a drug administered intravenously called infliximab (Remicade) that works to slow down the inflammatory process in the digestive tract.

Crohn's disease presents as ulcerations similar to ulcerative colitis. But unlike colitis, which remains on the inside surface of the colon, Crohn's can appear anywhere from the mouth to the rectum. It begins with ulcers, usually in the terminal ileum (connection between the large and small intestines and near the appendix), that burrow deep into the intestine and can spread through intestinal wall and into other sections of the intestines. In extreme cases, fistulas, which are deep ulcer tracts, can burrow through the intestinal wall to adjacent segments of the intestines, other organs, or to the skin's surface.

Dowdle said that patients usually experience extreme, chronic, often bloody diarrhea and abdominal pain and cramping. This is accompanied by malabsorption of nutrients from food, fatigue, fever and dehydration. Crohn's patients are usually thin and nutritionally compromised.

“Crohn's is an auto-immune disease," Dowdle said. "The body's immune system somehow sees the intestines as the enemy. It begins attacking the intestines as a foreign object creating chronic and uncontrolled inflammation." Researchers have yet to determine the origin of the disease. Infection, environmental insult, genetic predisposition are all possibilities, but it is known that the disease seems to strike people in their 20s and 60s affecting males and females equally.

A physician's response to a diagnosis of Crohn's disease is to try to induce remission initially using prednisone and adding sulfasalazine or mesalamine in hopes of reducing inflammation. Ultimately, a Crohn's disease patient may have to be maintained on the same immunosuppressive drugs used for organ transplant patients, such as Axathioprine or 6-mercaptopurine.

“This down-regulates the body's immune system,” Dowdle said, explaining that has been the best way to manage the inflammation and tissue damage. “But we still have patients who fail miserably.” Even surgery, which is used sparingly, fails to cure the disease. Dowdle said that after surgically removing an ulcerated section of intestines, more ulcers or strictures often appear where the intestines are reconnected, sometimes making an ostomy the only recourse.

Infliximab (Remicade), the first new drug to prove effective in treating Crohn's in 30 years, has shown good results by slowing down the inflammatory process, Dowdle said. She explained that in Crohn's patients, tumor necrosis factor alpha (TNFa) appears to become “revved up.” Its normal protective function is out of control. TNFa is one of the modulators that creates the intestinal inflammation, and Remicade targets this.

“It's believed the drug shuts down or binds to TNFa and facilitates the healing process,” Dowdle said. “But the effect isn't permanent, and it's not known what the effects of the drug are in the long term. It is only appropriate for mild to moderate disease or fistulizing disease. Unfortunately it is of little value to the severe patients with strictures.”

Dowdle said that clinicians hope that infliximab will prove to be a good "bridge" drug to spare the use of prednisone, which can have severe side effects with extended use.

“This is the beginning of a new era for IBD patients,” Dowdle said. “There are many new drugs in the research phase and clinical trials phase for Crohn's disease as well as for ulcerative colitis. We look forward to offering these new advances to our patients when they become available.”